Duke’s back doctors use advanced techniques and tools to reduce or eliminate your lower back pain, upper back pain, and everything in between. Back pain is extremely common, and while back pain can have many causes, the source is rarely serious. We use a wide range of tests to learn more about your specific condition. Our goal is to find the most effective, least-invasive treatment option that manages or eliminates your pain and maximizes your ability to function.
Duke’s Spine Health Program providers will evaluate your back pain and offer conservative treatment options like chiropractic care, physical therapy, acupuncture, massage, yoga, mindfulness, and more. If and when you need it, we won’t hesitate to refer you for more advanced care.
Back pain can occur along any part of the spine and in your back’s muscles, soft tissues, joints, bones, and nerves. Acute back pain often comes on suddenly, lasts less than six weeks, and usually gets better with rest and time. Common causes include pulling a muscle from lifting something heavy, twisting awkwardly, or playing sports.
Chronic back pain, on the other hand, lasts more than three months, may not have an easily identifiable single cause, and may require help to get better.
The severity, source, and type of your back pain will guide your treatment plan, and conservative options are usually the first step. If these solutions don’t provide enough relief, you may be a candidate for back surgery.
Complementary Pain Management
A range of experts can help you understand the mental and emotional aspects of back pain, develop skills and strategies to cope with it, and improve your quality of life. More holistic options like massage therapy, biofeedback, and meditation could resolve your back pain on their own, or they may complement more traditional treatments.
Acupuncture
Using fine needles placed strategically in the skin, acupuncture stimulates the central nervous system and releases chemicals that promote healing.
Chiropractic Care
A skilled chiropractor uses spinal manipulation and other manual methods to help relieve back pain and other symptoms such as numbness and tingling, loss of strength, or pain in the arms or legs. These hands-on techniques stretch and move the spine to restore mobility to joints restricted by injury or repetitive stress, such as sitting without proper back support. Our chiropractors can also teach you exercises for improving strength and flexibility and incorporating safe movements and proper posture into your daily activities.
Physical Therapy
A trained physical therapist guides you in exercises and stretches designed to strengthen your back, improve your balance and flexibility, and improve range of motion -- all benefits that can alleviate your pain and protect your spine from future injury. Physical therapists will teach you stretches and exercises to do on your own to prevent further episodes of spine pain.
Medication
Medications include over-the-counter pain relievers, prescription-grade anti-inflammatory drugs, and occasionally short courses of muscle relaxers, nerve-pain medicines, and others. Our back doctors balance medication recommendations with risks of side effects, dependency, or other unwanted reactions.
Short-Term Bracing
In some cases, including trauma and fractures or instability of the spine, your doctors may recommend wearing a rigid or semi-rigid back brace for a short time. This stabilizes your spine, allowing it to heal and helping prevent additional injury.
Electrical Stimulation
A TENS (transcutaneous electrical nerve stimulator) unit can be used in your doctor’s office or at home. A portable version is small enough to hold in your hand. When you are experiencing pain, you place reusable electrodes on your back and attach them with wires to the TENS device. Then you turn on the device to deliver mild electricity (it should not hurt) through your skin for 15 to 30 minutes. This stimulates your nerves and stops pain receptors in the brain.
Duke Health offers locations throughout the Triangle. Find one near you.
Epidural steroid injections treat inflammation and pain right at the source -- your pinched nerves. Other injections target abnormalities or pain from certain joints. Using precise X-ray imaging to guide them, doctors numb the skin over the injection site and place a needle close to the pain source in your spine. They may inject medication, which usually begins reducing pain within a few days to a week. Or they may use ablation, which applies radiofrequency energy to damage your nerve so that it no longer sends pain signals to your brain. For each of these options, you’ll feel pressure during the injection. You may be able to return to normal activities that day. Some people require more than one injection to start feeling better.
Your doctor will likely recommend beginning conservative treatment before ordering tests like those listed below. This is because research shows that undergoing testing too early can cause more harm than good. (For example, X-ray and MRI scans may only be recommended when back pain persists for four to six weeks after beginning conservative treatment.) Our providers carefully weigh these considerations when determining what testing is right for you and when.
X-Rays
By taking pictures of bones and joints in your back, X-rays can help identify fractures, tumors, dislocations, bone spurs, instability, or other potential causes of pain. They show the alignment of your spine to help detect scoliosis or spondylolisthesis.
MRI (Magnetic Resonance Imaging)
Magnetic waves create detailed pictures of your spine, including your discs, nerves, and soft tissues. Images can help identify disc damage or pinched nerves.
CT (Computed Tomography)
A series of cross-sectional pictures produce detailed, 3D images of your bones.
Nerve Conduction Study and Electromyogram (EMG)
These tests can help determine whether nerves outside of the spine are contributing to your back pain. Electrodes are inserted directly into muscle with a thin needle. By measuring how fast electrical signals move through your nerves, the test identifies nerve damage and assesses muscle function.
Where you receive your care matters. Duke University Hospital is proud of our team and the exceptional care they provide. They are why our orthopaedics, neurology, and neurosurgery programs are nationally ranked and are the highest-ranked programs in North Carolina, according to U.S. News & World Report for 2025–2026.
Team of Specialists
Our multidisciplinary team includes physical and occupational therapists, a massage therapist, acupuncturists, a chiropractor, physiatrists (physical medicine and rehabilitation doctors) who specialize in conservative spine care, pain management specialists, orthopedic and neurosurgery experts, psychologists, and others. We work together to ensure you receive comprehensive, thorough care.
We Listen to You
Our providers take pride in working alongside you to decide on the best course of treatment. We are sensitive to your treatment preferences, will never push you to have surgery, offer non-interventional alternative treatment options, and respect your wishes to avoid certain medications or procedures.
